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Morningstar J, Lee J, Mahon S, Brenner M, Nath AK. Mass Spectrometric Analysis of Purine Intermediary Metabolism Indicates Cyanide Induces Purine Catabolism in Rabbits. Metabolites 2024; 14:279. [PMID: 38786756 PMCID: PMC11123099 DOI: 10.3390/metabo14050279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Purines are the building blocks of DNA/RNA, energy substrates, and cofactors. Purine metabolites, including ATP, GTP, NADH, and coenzyme A, are essential molecules in diverse biological processes such as energy metabolism, signal transduction, and enzyme activity. When purine levels increase, excess purines are either recycled to synthesize purine metabolites or catabolized to the end product uric acid. Purine catabolism increases during states of low oxygen tension (hypoxia and ischemia), but this metabolic pathway is incompletely understood in the context of histotoxic hypoxia (i.e., inhibition of oxygen utilization despite normal oxygen tension). In rabbits exposed to cyanide-a classical histotoxic hypoxia agent-we demonstrated significant increases in several concordant metabolites in the purine catabolic pathway (including plasma levels of uric acid, xanthosine, xanthine, hypoxanthine, and inosine) via mass spectrometry-based metabolite profiling. Pharmacological inhibition of the purine catabolic pathway with oxypurinol mitigated the deleterious effects of cyanide on skeletal muscle cytochrome c oxidase redox state, measured by non-invasive diffuse optical spectroscopy. Finally, plasma uric acid levels correlated strongly with those of lactic acid, an established clinical biomarker of cyanide exposure, in addition to a tissue biomarker of cyanide exposure (skeletal muscle cytochrome c oxidase redox state). Cumulatively, these findings not only shed light on the in vivo role(s) of cyanide but also have implications in the field of medical countermeasure (MCM) development.
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Affiliation(s)
- Jordan Morningstar
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
| | - Sari Mahon
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
| | - Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, CA 92697, USA (S.M.); (M.B.)
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Anjali K. Nath
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02215, USA
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2
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Seong M, Oh Y, Park HJ, Choi WS, Kim JG. Use of Hypoxic Respiratory Challenge for Differentiating Alzheimer's Disease and Wild-Type Mice Non-Invasively: A Diffuse Optical Spectroscopy Study. BIOSENSORS 2022; 12:1019. [PMID: 36421136 PMCID: PMC9688818 DOI: 10.3390/bios12111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Alzheimer's disease is one of the most critical brain diseases. The prevalence of the disease keeps rising due to increasing life spans. This study aims to examine the use of hemodynamic signals during hypoxic respiratory challenge for the differentiation of Alzheimer's disease (AD) and wild-type (WT) mice. Diffuse optical spectroscopy, an optical system that can non-invasively monitor transient changes in deoxygenated (ΔRHb) and oxygenated (ΔOHb) hemoglobin concentrations, was used to monitor hemodynamic reactivity during hypoxic respiratory challenges in an animal model. From the acquired signals, 13 hemodynamic features were extracted from each of ΔRHb and -ΔOHb (26 features total) for more in-depth analyses of the differences between AD and WT. The hemodynamic features were statistically analyzed and tested to explore the possibility of using machine learning (ML) to differentiate AD and WT. Among the twenty-six features, two features of ΔRHb and one feature of -ΔOHb showed statistically significant differences between AD and WT. Among ML techniques, a naive Bayes algorithm achieved the best accuracy of 84.3% when whole hemodynamic features were used for differentiation. While further works are required to improve the approach, the suggested approach has the potential to be an alternative method for the differentiation of AD and WT.
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Affiliation(s)
- Myeongsu Seong
- School of Information Science and Technology, Nantong University, Nantong 226019, China
- Research Center for Intelligent Information Technology, Nantong University, Nantong 226019, China
| | - Yoonho Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Hyung Joon Park
- School of Biological Sciences and Technology, College of Natural Sciences, College of Medicine, Chonnam National University, Gwangju 61186, Republic of Korea
- Department of Biochemistry, University of Washington, Seattle, WA 98195, USA
| | - Won-Seok Choi
- School of Biological Sciences and Technology, College of Natural Sciences, College of Medicine, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jae Gwan Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
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3
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Glyoxylate protects against cyanide toxicity through metabolic modulation. Sci Rep 2022; 12:4982. [PMID: 35322094 PMCID: PMC8943054 DOI: 10.1038/s41598-022-08803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/09/2022] Open
Abstract
Although cyanide's biological effects are pleiotropic, its most obvious effects are as a metabolic poison. Cyanide potently inhibits cytochrome c oxidase and potentially other metabolic enzymes, thereby unleashing a cascade of metabolic perturbations that are believed to cause lethality. From systematic screens of human metabolites using a zebrafish model of cyanide toxicity, we have identified the TCA-derived small molecule glyoxylate as a potential cyanide countermeasure. Following cyanide exposure, treatment with glyoxylate in both mammalian and non-mammalian animal models confers resistance to cyanide toxicity with greater efficacy and faster kinetics than known cyanide scavengers. Glyoxylate-mediated cyanide resistance is accompanied by rapid pyruvate consumption without an accompanying increase in lactate concentration. Lactate dehydrogenase is required for this effect which distinguishes the mechanism of glyoxylate rescue as distinct from countermeasures based solely on chemical cyanide scavenging. Our metabolic data together support the hypothesis that glyoxylate confers survival at least in part by reversing the cyanide-induced redox imbalances in the cytosol and mitochondria. The data presented herein represent the identification of a potential cyanide countermeasure operating through a novel mechanism of metabolic modulation.
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4
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Lam JH, Tu KJ, Kim S. Accurately calibrated frequency domain diffuse optical spectroscopy compared against chemical analysis of porcine adipose tissue. JOURNAL OF BIOPHOTONICS 2021; 14:e202100169. [PMID: 34498790 DOI: 10.1002/jbio.202100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Frequency domain diffuse optical spectroscopy (fdDOS) is a noninvasive technique to estimate tissue composition and hemodynamics. While fdDOS has been established as a valuable modality for clinical research, comparison of fdDOS with direct chemical analysis (CA) methods has yet to be reported. To compare the two approaches, we propose a procedure to confirm accurate calibration by use of liquid emulsion and solid silicone phantoms. Tissue fat (FAT) and water (H2 O) content of two ex vivo porcine tissue samples were optically measured by fdDOS and compared to CA values. We show an average H2 O error (fdDOS minus CA) and SD of 1.9 ± 0.2% and -0.9 ± 0.2% for the two samples. For FAT, we report a mean error of -9.3 ± 1.3% and 0.8 ± 1.3%. We also measured various body sites of a healthy human subject using fdDOS with results suggesting that accurate calibration may improve device sensitivity.
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Affiliation(s)
- Jesse H Lam
- Beckman Laser Institute Korea, Dankook University, Cheonan-si, South Korea
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Kelsey J Tu
- Department of Biomedical Engineering, Dankook University, Cheonan-si, South Korea
| | - Sehwan Kim
- Beckman Laser Institute Korea, Dankook University, Cheonan-si, South Korea
- MEDiThings, Dankook University, Cheonan-si, South Korea
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5
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de Vries RJ, Cronin SEJ, Romfh P, Pendexter CA, Jain R, Wilks BT, Raigani S, van Gulik TM, Chen P, Yeh H, Uygun K, Tessier SN. Non-invasive quantification of the mitochondrial redox state in livers during machine perfusion. PLoS One 2021; 16:e0258833. [PMID: 34705828 PMCID: PMC8550443 DOI: 10.1371/journal.pone.0258833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
Ischemia reperfusion injury (IRI) is a critical problem in liver transplantation that can lead to life-threatening complications and substantially limit the utilization of livers for transplantation. However, because there are no early diagnostics available, fulminant injury may only become evident post-transplant. Mitochondria play a central role in IRI and are an ideal diagnostic target. During ischemia, changes in the mitochondrial redox state form the first link in the chain of events that lead to IRI. In this study we used resonance Raman spectroscopy to provide a rapid, non-invasive, and label-free diagnostic for quantification of the hepatic mitochondrial redox status. We show this diagnostic can be used to significantly distinguish transplantable versus non-transplantable ischemically injured rat livers during oxygenated machine perfusion and demonstrate spatial differences in the response of mitochondrial redox to ischemia reperfusion. This novel diagnostic may be used in the future to predict the viability of human livers for transplantation and as a tool to better understand the mechanisms of hepatic IRI.
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Affiliation(s)
- Reinier J. de Vries
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
- Department of Surgery, Amsterdam University Medical Centers–Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie E. J. Cronin
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Padraic Romfh
- Pendar Technologies, Cambridge, MA, United States of America
| | - Casie A. Pendexter
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Rohil Jain
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Benjamin T. Wilks
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Siavash Raigani
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | - Thomas M. van Gulik
- Department of Surgery, Amsterdam University Medical Centers–Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Peili Chen
- Pendar Technologies, Cambridge, MA, United States of America
| | - Heidi Yeh
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | - Korkut Uygun
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
| | - Shannon N. Tessier
- Center for Engineering in Medicine and Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States of America
- Shriners Hospitals for Children—Boston, Boston, MA, United States of America
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6
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Lam JH, Hill B, Quang T, Amelard R, Kim S, Yazdi HS, Warren RV, Cutler KB, Tromberg BJ. Multi-modal diffuse optical spectroscopy for high-speed monitoring and wide-area mapping of tissue optical properties and hemodynamics. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210158RR. [PMID: 34390234 PMCID: PMC8362892 DOI: 10.1117/1.jbo.26.8.085002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/30/2021] [Indexed: 05/15/2023]
Abstract
SIGNIFICANCE Diffuse optical spectroscopic imaging (DOSI) is a versatile technology sensitive to changes in tissue composition and hemodynamics and has been used for a wide variety of clinical applications. Specific applications have prompted the development of versions of the DOSI technology to fit specific clinical needs. This work describes the development and characterization of a multi-modal DOSI (MM-DOSI) system that can acquire metabolic, compositional, and pulsatile information at multiple penetration depths in a single hardware platform. Additionally, a 3D tracking system is integrated with MM-DOSI, which enables registration of the acquired data to the physical imaging area. AIM We demonstrate imaging, layered compositional analysis, and metabolism tracking capabilities using a single MM-DOSI system on optical phantoms as well as in vivo human tissue. APPROACH We characterize system performance with a silicone phantom containing an embedded object. To demonstrate multi-layer sensitivity, we imaged human calf tissue with a 4.8-mm skin-adipose thickness. Human thenar tissue was also measured using a combined broadband DOSI and continuous-wave near-infrared spectroscopy method (∼15 Hz acquisition rate). RESULTS High-resolution optical property maps of absorption (μa) and reduced scattering (μs ' ) were recovered on the phantom by capturing over 1000 measurement points in under 5 minutes. On human calf tissue, we show two probing depth layers have significantly different (p < 0.001) total-hemo/myoglobin and μs ' composition. On thenar tissue, we calculate tissue arterial oxygen saturation, venous oxygen saturation, and tissue metabolic rate of oxygen consumption during baseline and after release of an arterial occlusion. CONCLUSIONS The MM-DOSI can switch between collection of broadband spectra, high-resolution images, or multi-depth hemodynamics without any hardware reconfiguration. We conclude that MM-DOSI enables acquisition of high resolution, multi-modal data consolidated in a single platform, which can provide a more comprehensive understanding of tissue hemodynamics and composition for a wide range of clinical applications.
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Affiliation(s)
- Jesse H. Lam
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
- Dankook University, Beckman Laser Institute Korea, School of Medicine, Cheonan, Chungnam, Republic of Korea
| | - Brian Hill
- National Institutes of Health, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Timothy Quang
- National Institutes of Health, National Institute of Child Health and Human Development, Bethesda, Maryland, United States
| | - Robert Amelard
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Sehwan Kim
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
- Dankook University, Beckman Laser Institute Korea, School of Medicine, Cheonan, Chungnam, Republic of Korea
| | - Hossein S. Yazdi
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
| | - Robert V. Warren
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
| | - Kyle B. Cutler
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
| | - Bruce J. Tromberg
- University of California, Irvine, Beckman Laser Institute, Department of Biomedical Engineering, Irvine, California, United States
- National Institutes of Health, National Institute of Biomedical Imaging and Bioengineering, Bethesda, Maryland, United States
- Address all correspondence to Bruce J. Tromberg,
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7
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Morningstar J, Lee J, Hendry-Hofer T, Witeof A, Lyle LT, Knipp G, MacRae CA, Boss GR, Peterson RT, Davisson VJ, Gerszten RE, Bebarta VS, Mahon S, Brenner M, Nath AK. Intramuscular administration of hexachloroplatinate reverses cyanide-induced metabolic derangements and counteracts severe cyanide poisoning. FASEB Bioadv 2018; 1:81-92. [PMID: 31355359 PMCID: PMC6660183 DOI: 10.1096/fba.1024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cyanide is a highly toxic industrial chemical that is widely used by manufactures. Smoke inhalation during household fires is the most common source of cyanide poisoning while additional risks to civilians include industrial accidents and terrorist attacks. Despite the risks to large numbers of individuals, an antidote capable of administration at scale adequate for a mass casualty, prehospital scenario does not yet exist. Previously, we demonstrated that intravenous cisplatin analogues accelerate recovery from cyanide poisoning in mice and rabbits. Of the dozens of platinum‐based organometallic complexes tested, hexachloroplatinate (HCP) emerged as a promising lead compound, exhibiting strong affinity for cyanide and efficacy across model systems. Here, we show HCP is an antidote to lethal cyanide exposure and is importantly effective when delivered intramuscularly. The pharmacokinetic profile of HCP exhibited bioavailability in the systemic circulation 2.5 minutes post‐treatment and subsequent renal clearance of HCP‐cyanide. HCP restored parameters of cellular physiology including cytochrome c oxidase redox state and TCA cycle metabolism. We next validated these findings in a large animal model (swine). Finally, preclinical safety studies in mice revealed minimal toxicity. Cumulatively, these findings demonstrate that HCP is a promising lead compound for development of an intramuscular injectable cyanide antidote for mass casualty scenarios.
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Affiliation(s)
- Jordan Morningstar
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Jangwoen Lee
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Tara Hendry-Hofer
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Alyssa Witeof
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - L Tiffany Lyle
- Department of Comparative Pathology, Purdue University, West Lafayette, IN 47907, USA
| | - Gregg Knipp
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA
| | - Calum A MacRae
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Gerry R Boss
- Deparment of Medicine, University of California, San Diego, CA 92093, USA
| | - Randall T Peterson
- Deparment of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT 84112 USA
| | - Vincent J Davisson
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA
| | - Robert E Gerszten
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
| | - Vikhyat S Bebarta
- Deparment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Sari Mahon
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Matt Brenner
- Beckman Laser Institute and Department of Medicine, University of California, Irvine, CA 92697, USA
| | - Anjali K Nath
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.,Broad Institute, Cambridge, MA 02142, USA
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Lee J, Rockwood G, Logue B, Manandhar E, Petrikovics I, Han C, Bebarta V, Mahon SB, Burney T, Brenner M. Monitoring Dose Response of Cyanide Antidote Dimethyl Trisulfide in Rabbits Using Diffuse Optical Spectroscopy. J Med Toxicol 2018; 14:295-305. [PMID: 30094773 DOI: 10.1007/s13181-018-0680-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cyanide (CN) poisoning is a serious chemical threat from accidental or intentional exposures. Current CN exposure treatments, including direct binding agents, methemoglobin donors, and sulfur donors, have several limitations. Dimethyl trisulfide (DMTS) is capable of reacting with CN to form the less toxic thiocyanate with high efficiency, even without the sulfurtransferase rhodanese. We investigated a soluble DMTS formulation with the potential to provide a continuous supply of substrate for CN detoxification which could be delivered via intramuscular (IM) injection in a mass casualty situation. We also used non-invasive technology, diffuse optical spectroscopy (DOS), to monitor physiologic changes associated with CN exposure and reversal. METHODS Thirty-six New Zealand white rabbits were infused with a lethal dose of sodium cyanide solution (20 mg/60 ml normal saline). Animals were divided into three groups and treated with saline, low dose (20 mg), or high dose (150 mg) of DMTS intramuscularly. DOS continuously assessed changes in tissue hemoglobin concentrations and cytochrome c oxidase redox state status throughout the experiment. RESULTS IM injection of DMTS increased the survival in lethal CN poisoning. DOS demonstrated that high-dose DMTS (150 mg) reversed the effects of CN exposure on cytochrome c oxidase, while low dose (20 mg) did not fully reverse effects, even in surviving animals. CONCLUSIONS This study demonstrated potential efficacy for the novel approach of supplying substrate for non-rhodanese mediated sulfur transferase pathways for CN detoxification via intramuscular injection in a moderate size animal model and showed that DOS was useful for optimizing the DMTS treatment.
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Affiliation(s)
- Jangwoen Lee
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA.
| | - Gary Rockwood
- Analytical Toxicology Division, US Army Medical Research Institute of Chemical Defense, 2900 Rickets Point Road, Aberdeen Proving Ground, Aberdeen, MD, 21010, USA
| | - Brian Logue
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Erica Manandhar
- Department of Chemistry and Biochemistry, South Dakota University, Brookings, SD, 57007, USA
| | - Ilona Petrikovics
- Department of Chemistry, Sam Houston State University, Huntsville, TX, 77341, USA
| | - Changhoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, 10444, South Korea
| | - Vik Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
| | - Matthew Brenner
- Beckman Laser Institute, University of California, 1002 Health Sciences Rd. East, Irvine, CA, 92612, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, CA, 92868, USA
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Perry DA, Salvin JW, Romfh P, Chen P, Krishnamurthy K, Thomson LM, Polizzotti BD, McGowan FX, Vakhshoori D, Kheir JN. Responsive monitoring of mitochondrial redox states in heart muscle predicts impending cardiac arrest. Sci Transl Med 2018; 9:9/408/eaan0117. [PMID: 28931652 DOI: 10.1126/scitranslmed.aan0117] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/20/2017] [Accepted: 08/15/2017] [Indexed: 11/02/2022]
Abstract
Assessing the adequacy of oxygen delivery to tissues is vital, particularly in the fields of intensive care medicine and surgery. As oxygen delivery to a cell becomes deficient, changes in mitochondrial redox state precede changes in cellular function. We describe a technique for the continuous monitoring of the mitochondrial redox state on the epicardial surface using resonance Raman spectroscopy. We quantify the reduced fraction of specific electron transport chain cytochromes, a metric we name the resonance Raman reduced mitochondrial ratio (3RMR). As oxygen deficiency worsens, heme moieties within the electron transport chain become progressively more reduced, leading to an increase in 3RMR. Myocardial 3RMR increased from baseline values of 18.1 ± 5.9 to 44.0 ± 16.9% (P = 0.0039) after inferior vena cava occlusion in rodents (n = 8). To demonstrate the diagnostic power of this measurement, 3RMR was continuously measured in rodents (n = 31) ventilated with 5 to 8% inspired oxygen for 30 min. A 3RMR value exceeding 40% at 10 min predicted subsequent cardiac arrest with 95% sensitivity and 100% specificity [area under the curve (AUC), 0.98], outperforming all current measures, including contractility (AUC, 0.51) and ejection fraction (AUC, 0.39). 3RMR correlated with indices of intracellular redox state and energy production. This technique may permit the real-time identification of critical defects in organ-specific oxygen delivery.
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Affiliation(s)
- Dorothy A Perry
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Joshua W Salvin
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | | | - Peili Chen
- Pendar Technologies, Cambridge, MA 02138, USA
| | | | - Lindsay M Thomson
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Brian D Polizzotti
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, PA 19104, USA.,Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - John N Kheir
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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10
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Abstract
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
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Affiliation(s)
- Chris Markham
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA
| | - Sara Small
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Peter Hovmand
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
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11
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Brenner M, Azer SM, Oh KJ, Han CH, Lee J, Mahon SB, Du X, Mukai D, Burney T, Saidian M, Chan A, Straker DI, Bebarta VS, Boss GR. Oral Glycine and Sodium Thiosulfate for Lethal Cyanide Ingestion. ACTA ACUST UNITED AC 2017; 7. [PMID: 28868209 PMCID: PMC5578424 DOI: 10.4172/2167-7972.1000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective Accidental or intentional cyanide ingestion is an-ever present danger. Rapidly acting, safe, inexpensive oral cyanide antidotes are needed that can neutralize large gastrointestinal cyanide reservoirs. Since humans cannot be exposed to cyanide experimentally, we studied oral cyanide poisoning in rabbits, testing oral sodium thiosulfate with and without gastric alkalization. Setting University research laboratory. Subjects New Zealand white rabbits. Interventions Seven animal groups studied; Groups 1–5 received high dose oral NaCN (50 mg, >LD100) and were treated immediately with oral (via nasogastric tube): 1) saline, 2) glycine, 3) sodium thiosulfate or 4) sodium thiosulfate and glycine, or 5) after 2 min with intramuscular injection of sodium nitrite and sodium thiosulfate plus oral sodium thiosulfate and glycine. Groups 6–7 received moderate dose oral NaCN (25 mg, LD70) and delayed intramuscular 6) saline or 7) sodium nitrite-sodium thiosulfate. Measurements and Main Results All animals in the high dose NaCN group receiving oral saline or glycine died very rapidly, with a trend towards delayed death in glycine-treated animals; saline versus glycine-treated animals died at 10.3+3.9 and 14.6+5.9 min, respectively (p=0.13). In contrast, all sodium thiosulfate-treated high dose cyanide animals survived (p<0.01), with more rapid recovery in animals receiving both thiosulfate and glycine, compared to thiosulfate alone (p<0.03). Delayed intramuscular treatment alone in the moderate cyanide dose animals increased survival over control animals from 30% to 71%. Delayed treatment in high dose cyanide animals was not as effective as immediate treatment, but did increase survival time and rescued 29% of animals (p<0.01 versus cyanide alone). Conclusions Oral sodium thiosulfate with gastric alkalization rescued animals from lethal doses of ingested cyanide. The combination of oral glycine and sodium thiosulfate may have potential for treating high dose acute cyanide ingestion and merits further investigation. The combination of systemic and oral therapy may provide further options.
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Affiliation(s)
- Matthew Brenner
- Beckman Laser Institute, University of California, Irvine, California, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Irvine, California, USA
| | - Sarah M Azer
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Kyung-Jin Oh
- Department of Urology, Chonnam National University Medical School, South Korea
| | - Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Geonggi-do, South Korea
| | - Jangwoen Lee
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Sari B Mahon
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Xiaohua Du
- Pulmonary Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - David Mukai
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Tanya Burney
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Mayer Saidian
- Beckman Laser Institute, University of California, Irvine, California, USA.,The Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Jerusalem Israel
| | - Adriano Chan
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Derek I Straker
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Vikhyat S Bebarta
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gerry R Boss
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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The Vitamin B 12 Analog Cobinamide Is an Effective Antidote for Oral Cyanide Poisoning. J Med Toxicol 2016; 12:370-379. [PMID: 27631586 DOI: 10.1007/s13181-016-0566-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Cyanide is a major chemical threat, and cyanide ingestion carries a higher risk for a supra-lethal dose exposure compared to inhalation but provides an opportunity for effective treatment due to a longer treatment window and a gastrointestinal cyanide reservoir that could be neutralized prior to systemic absorption. We hypothesized that orally administered cobinamide may function as a high-binding affinity scavenger and that gastric alkalinization would reduce cyanide absorption and concurrently increase cobinamide binding, further enhancing antidote effectiveness. METHODS Thirty New Zealand white rabbits were divided into five groups and were given a lethal dose of oral cyanide poisoning (50 mg). The survival time of animals was monitored with oral cyanide alone, oral cyanide with gastric alkalinization with oral sodium bicarbonate buffer (500 mg), and in combination with either aquohydroxocobinamide or dinitrocobinamide (250 mM). Red blood cell cyanide concentration, plasma cobinamide, and thiocyanate concentrations were measured from blood samples. RESULTS In cyanide ingested animals, oral sodium bicarbonate alone significantly prolonged survival time to 20.3 ± 8.6 min compared to 10.5 ± 4.3 min in saline-treated controls, but did not lead to overall survival. Aquohydroxocobinamide and dinitrocobinamide increased survival time to 64 ± 41 (p < 0.05) and 75 ± 16.4 min (p < 0.001), respectively. Compared to aquohydroxocobinamide, dinitrocobinamide showed greater systemic absorption and reduced blood pressure. Dinitrocobinamide also markedly increased the red blood cell cyanide concentration. Under all conditions, the plasma thiocyanate concentration gradually increased with time. CONCLUSION This study demonstrates a promising new approach to treat high-dose cyanide ingestion, with gastric alkalinization alone and in combination with oral cobinamide for treating a supra-lethal dose of orally administered cyanide in rabbits.
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13
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Arifler D, Zhu T, Madaan S, Tachtsidis I. Optimal wavelength combinations for near-infrared spectroscopic monitoring of changes in brain tissue hemoglobin and cytochrome c oxidase concentrations. BIOMEDICAL OPTICS EXPRESS 2015; 6:933-47. [PMID: 25798316 PMCID: PMC4361446 DOI: 10.1364/boe.6.000933] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 05/19/2023]
Abstract
We analyze broadband near-infrared spectroscopic measurements obtained from newborn piglets subjected to hypoxia-ischemia and we aim to identify optimal wavelength combinations for monitoring cerebral tissue chromophores. We implement an optimization routine based on the genetic algorithm to perform a heuristic search for discrete wavelength combinations that can provide accurate concentration information when benchmarked against the gold standard of 121 wavelengths. The results indicate that it is possible to significantly reduce the number of measurement wavelengths used in conjunction with spectroscopic algorithms and still achieve a high performance in estimating changes in concentrations of oxyhemoglobin, deoxyhemoglobin, and oxidized cytochrome c oxidase. While the use of a 3-wavelength combination leads to mean recovery errors of up to 10%, these errors drop to less than 4% with 4 or 5 wavelengths and to even less than 2% with 8 wavelengths.
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Affiliation(s)
- Dizem Arifler
- Physics Group, Middle East Technical University, Northern Cyprus Campus, Kalkanli, via Mersin 10
Turkey
| | - Tingting Zhu
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
| | - Sara Madaan
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT,
UK
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Chan A, Jiang J, Fridman A, Guo LT, Shelton GD, Liu MT, Green C, Haushalter KJ, Patel HH, Lee J, Yoon D, Burney T, Mukai D, Mahon SB, Brenner M, Pilz RB, Boss GR. Nitrocobinamide, a new cyanide antidote that can be administered by intramuscular injection. J Med Chem 2015; 58:1750-9. [PMID: 25650735 DOI: 10.1021/jm501565k] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently available cyanide antidotes must be given by intravenous injection over 5-10 min, making them ill-suited for treating many people in the field, as could occur in a major fire, an industrial accident, or a terrorist attack. These scenarios call for a drug that can be given quickly, e.g., by intramuscular injection. We have shown that aquohydroxocobinamide is a potent cyanide antidote in animal models of cyanide poisoning, but it is unstable in solution and poorly absorbed after intramuscular injection. Here we show that adding sodium nitrite to cobinamide yields a stable derivative (referred to as nitrocobinamide) that rescues cyanide-poisoned mice and rabbits when given by intramuscular injection. We also show that the efficacy of nitrocobinamide is markedly enhanced by coadministering sodium thiosulfate (reducing the total injected volume), and we calculate that ∼1.4 mL each of nitrocobinamide and sodium thiosulfate should rescue a human from a lethal cyanide exposure.
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Affiliation(s)
- Adriano Chan
- Departments of †Medicine, ‡Pathology, §Chemistry and Biochemistry, and ∥Anesthesiology, University of California-San Diego , La Jolla, California 92093-0652, United States
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